Ask Jodi

Too much sweat?

Posted on by Jodi LoGerfo

Question: Is there such a thing as sweating too much? What can I do about it if I’m constantly soaking through my clothes? It’s so embarrassing, especially at work!

Answer: Yes, the condition definitely heats up during the summer months but can plague sufferers all year long with overly sweaty armpits, palms and even on soles of the feet. It is called hyperhidrosis which just means “excessive sweating.”

Hyperhidrosis is simply abnormally heavy perspiration. Sweating is a normal bodily function, but some people may have overactive sweat glands that produce more sweat beyond what is required for regulation of body temperature. It can be most noticeable at the armpits because sweat can soak through clothing and become obviously embarrassing. Or you may also be aware your palms are often sweaty so you avoid shaking hands with others. Hyperhidrosis can occur in many parts of the body whether exposed to triggers such as heat, physical activity or exertion, embarrassment, stress or not.

How do we treat excessive sweating?

First, we’ll evaluate your excessive sweating for any potential causes of secondary hyperhidrosis (for example, an underlying disease that causes excessive sweating such as hyperthyroidism).

To gauge your sweating problem, we will try you on stronger prescription-grade antiperspirants which can also help block sweat glands to reduce sweating. Typical over-the-counter antiperspirants are 1-2% aluminum chloride but prescription products can contain up to a 20% solution of aluminum chloride hexahydrate or similar aluminum salts. While these can be irritating in those with sensitive skin and sweat glands, they do reduce perspiration, however they require continuous usage.

After a few weeks of trial, if the prescription products do not reduce your sweating problem well enough, we can now use Botox® (onabotulinumtoxinA), which is FDA approved for the treatment of excessive sweating of armpits. We also use Myobloc® (rimabotulinumtoxinB) or Dysport® (abobotulinumtoxinA) off-label as an alternative, especially for those who have excessive sweating on palms and soles of feet.

These injections work to temporarily de-nerve the sweat gland and results in a local reduction in sweating where injections have been administered for up 5 months. Injections must be repeated at regular intervals to keep excessive sweating at bay and you may still need to use an antiperspirant.

-Jodi

Prescription retinoids versus drug-store retinols

Posted on by Jodi LoGerfo

Question: I’ve seen plenty of products in the drug store skincare aisle that contain retinol and say they reduce the appearance of fine lines while balancing an uneven complexion. Is this the same as the Retin-A products I can get by prescription?

Answer: While they are both derivatives of Vitamin A, called “retinoids,” and used to promote faster skin cell turnover, they are not the same.

Read drug store retinol cream labels looking for vitamin A!

All retinoids have been well-studied, tested and been proven effective and powerful for treating skin issues ranging from acne to many signs of aging, including sun damage.But there is a marked difference between retinoid products you get only by prescription and the retinol products you see on drug-store shelves.

Retinoid products are prescription-only skincare products containing the most commonly-known natural vitamin A derivative, tretinoin which comes in name brands such as Atralin, Retin-A (and Micro) among others.  These proven prescription products increase the rate of cell turnover to uncover healthier skin-whether it’s reducing fine lines or evening out the texture or color of your skin.  Common side effects include dryness, redness, cracking,  irritation and skin peeling. There are two other prescription strength (lesser known) prescription retinoids-tazarotene (Tazorac) and adapalene (Differin).

If you find, during the dead of winter, that dryness, peeling, redness and cracking are more pronounced, simply reduce the usage of your prescription retinoid to just once per day, or every other day or even every two or three days until side effects are diminished. By the way, winter weather and drier indoor heat may be exacerbating your already winter-dry skin, if you need to use them less don’t worry, the powerful retinoids still do their job!

Retinol products don’t require a prescription so you can buy them over-the-counter at the drug store or grocery store, without a prescription. Retinols are simply a synthetic, weaker version of a retionid and as such, they act more slowly than a retinoid. However, these products can be useful if you find prescription retinoid products too strong for your skin. They are also a good beginning step to starting your skin on a topical retinoid.

When choosing a drug store retinol product, check the ingredients list to make sure vitamin A is listed toward the top of the ingredients list. Also, in terms of packaging, look for an air-tight bottle that keeps the light out (exposure to light makes the products less stable and effective and more susceptible to bacteria growth.)

Other skin tips:

  • Reduce your skin’s exposure to hot-hot water.
  • Add a humidifier to rooms where you spend a lot of time.
  • Use an emollient (thick) cream to counter peeling and cracking skin.
  • Always wear sunscreen.

-Jodi

Active? Watch out for a mucocele

Posted on by Jodi LoGerfo

Question:  Help – what is this bluish, clear very noticeable round lump on my lower lip?

Any face-first fall can cause a mucoceleAnswer: I had a young patient come into the office this week with just that:  A clear, bluish-tinted  bump on her lower lip. It was more than just a "fat lip." I immediately suspected a mucocele because of the bluish tint, roundness and the lower lip placement, so I asked the mom if her daughter had hit or bumped her lip in some way. Yes, she had been riding her bike and fell, hitting that portion of her lip against her teeth.

But a mucocele is not just a child's occurrence…it can happen to anyone who bumps their lower lip on anything which can be common in active adults when skiing, kayaking, climbing, mountain biking or other activities.

Luckily, a mucocele is easy to treat. Usually, just one soft, round, painless lesion (lump) appears noticeably on the lower lip, which may be anywhere from 2-10 mm in diameter. It may look clear or bluish and the bluish tint represents a bruising to the mucous duct from the trauma.The exact cause of the lump is a rupture of a minor salivary (mucous) duct, which causes a leaking of mucous into cystic spaces combined with inflammation from the trauma. 

As new connective tissue is formed, scarring may form. That's why I always drain the mucocele (cyst) of its excess fluid to allow the healing process to begin before any more damage to surrounding tissue occurs. A quick, tiny incision to the cyst releases the thick fluid. If scar tissue forms we may treat it using cryotherapy (freezing) or a laser resurfacing treatment.

I also recommend rinsing the mouth thoroughly with a mixture of one tablespoon of salt to one cup of warm water four to six times per day to help it heal.

A cyst like this can occur elsewhere in your mouth. Musicians who play wind instruments may develop a mucocele opposite the upper second molar on the inside of the cheek (called the buccal mucosa) from the repeated pressure on the mucous duct there.

A mucocele can also form anywhere in the mouth when there is a true blockage of a salivary duct (which may turn painful), so always see a dermatologist or dentist immediately if you see or feel a bump in your mouth.

-Jodi

What to do about an inflamed, raised, hard scar

Posted on by Jodi LoGerfo

Question: I had an injury to my shoulder earlier this year and while the wound has mostly healed and is no longer scabby, the resulting scar is still painful, raised, hard and lumpy. It's bigger and uglier than the original wound. What can I do? 

Keloid scar

Answer:

There are two types of scars that resemble what you describe and there's a lot we can do in the dermatologists office to help them look and feel better. 

This type of scarring is usually after local skin trauma (e.g., laceration, tattoo, burn, vaccination or surgery) or as a result of an inflammatory skin disorder (e.g., acne, bites or abscesses). 

Scars are composed of new connective tissue that replaces lost tissue in the dermis or deeper parts of the skin, as a result of injury. Their size and shape are determined by the form of the previous wound. The process of scarring is characteristic of certain inflammatory processes. A resulting scar can be thin (atrophic) or thickened, fibrous and overgrown. Some individuals and some areas of the body (e.g., anterior chest) are especially prone to scarring. Scars may be smooth or rough, pliable or firm, they can be pink or violaceous or become white. They can also be hyperpigmented (darkened). Scars are persistent and normally become less noticeable in the course of time. 

Keloids & Hypertrophic Scars 

At times though, and in certain anatomical locations (e.g., shoulders, sternum, mandible and arms) they can grow thick, tough and corded forming a hypertrophic scar or keloid. Under normal circumstances,  wound healing takes place through the rapid and repeated reproduction of fibroblasts (the most common cells of connective tissue) at the wound site. But when fibroblast activity continues unchecked and excessive collagen (protein found in connective tissue) is deposited at the site of injury, the scar gets too big and a hypertrophic scar or keloid is formed. 

A Hypertrophic Scar remains confined to the borders of the original wound and most of the time, retains its shape. It is characterized by hardness, redness and irritation compared to the surrounding skin and can take the form of a firm papule or nodule. 

Conversely, a Keloid is an overgrowth of dense fibrous tissue that you'll notice extending beyond the borders of the original wound. Like a hypertrophic scar, a keloid can be hardened, raised and often darkly discolored. Keloids do not regress, appear to get better or shrink over time on their own. Instead they grow in a pseudo tumor fashion and distort the size and shape of the original lesion. If you know you have a hereditary predisposition toward keloid scarring, mention that to your dermatologist because then we will not try to surgically remove them (called excision) because keloids tend to recur. 

The differences… A hypertrophic scar can occur at an any age and usually stays within the borders of the original wound, whereas a keloid commonly occurs in the third decade and enlarges beyond the area of the initial wounding with web-like extensions. Keloidal growth can also be triggered by pregnancy and compared with hypertrophic scars, a keloid can often be painful and super-sensitive. 

How we treat stubborn keloids and hypertrophic scarring 

We often use a 3-step process in the office to attack raised, hardened scars as soon as we notice a scar is exhibiting signs of hardening, as early as one month-post op, in the case of a scar due to surgery.  The earlier you treat a keloid or hypertrophic scar, the better your results will be. 

We inject  5-fluorouracil "5-FU" (used primarily as an anti-cancer drug but also used for the prevention of scars in glaucoma surgery for at least 15 years) combined with a specific low-dose corticosteroid (to reduce further inflammation and any pain) along with Pulsed Dye Laser treatments. 

5-FU works to reduce skin's metabolism rate and inhibits the over-production of the fibroblasts building up on and around the wound. We combine that with Kenalog (triamcinolone), the low-dose corticosteroid, and perform injections one to three times per week, at regular intervals such as Monday, Wednesday and Friday, depending on how red, hardened and inflamed the scar is. Once the scar softens, injections can be reduced to two times per week, once a week and then every other week, monthly and finally, every six months. The Pulsed Dye Laser is used to decrease any redness, to normalize the wound surface and improve skin texture at the scar and to further blend scar into surrounding skin and we perform those treatments in intervals of four to eight months apart. 

While any keloid or hypertrophic scar can be treated with this technique,  you'll get the best results the younger the scar is. The more inflamed and symptomatic the scar, the better the response to treatment. Older scars that have been hardened for many years and are not inflamed, red, itchy or painful, will not respond as quickly or as thoroughly. Hypertrophic scars respond better than keloids, which frequently recur, although small isolated keloids (less than 2 cm in diameter) usually completely resolve with this technique without recurrence. 

No matter what, keep all scars out of the sun for best healing, at least until the “pink” of new skin is gone because exposure to the sun only makes scars darker. 

-Jodi              

What good is coconut oil for hair and skin?

Posted on by Jodi LoGerfo

Question: I've been reading more and more about using coconut oil for hair and skin. Do you think this is a good idea? Can you tell me how to buy coconut oil and how to use it properly?

 As a solid its an ointment or balm, warmed to a liquid a liquid its a moisturizing, conditioning oil

Answer:

I love coconut oil as an added treat for hair and skin (as long as you are not allergic to nuts or coconut). But, I only recommend buying organic unrefined expeller-pressed virgin coconut oil (also called VCO).

VCO is a great addition to any hair and skin routine because:

  • It has no preservatives, additives or color.
  • It's available at any local health food store or online.
  • It's affordable at $9 for a small 14 ounce jar.
  • It's a multi-use beauty product
  • That smell is like being on a desert island (refined VCO  does not retain its natural coconut aroma).

The real beauty of VCO for skin and hair is its natural, molecular composition

Not only does VCO have a high saturated fat content-composed of 90% saturated triglycerides, but its low molecular weight and straight linear chain (called a medium-chain fatty acid, in contrast to other saturated fats comprised of long chain fatty acids which make them larger molecules), it is able to permeate the hair shaft  and skin surface rather than just sitting on top. That's what makes it so effective. If you use it at room temperature (when it is solid) it is the perfect ointment to relieve dehydrated, chapped, scaly and itchy skin and it can even improve symptoms of psoriasis and excema. But if you place the jar in warm water, it melts into a liquid oil perfect for massaging, baths, a moisturizer or a hair mask.

The medical literature supports my own observations of VCO as a healthful skin conditioner and moisturizer. Studies have shown that  VCO use may improve skin barrier function (protecting skin from bacteria and fungal intrusion) and  decrease trans-epidermal water loss (skin's ability to retain moisture). Animal studies have shown that coconut oil use can improve wound healing and increase collagen production, too. For hair, in addition to its high absorbability, VCO contains a high percentage of the saturated fat, lauric acid, which also is highly attracted to the protein in hair. Because VCO actually absorbs through the hair shaft, it has positive effects on the strength of hair while it prevents hair damage and protein loss from styling, brushing and even chemical treatments.  

A little coconut oil on your skin and hair goes a long way:

  • As a daily body moisturizer, after shower or bath
  • As a bath oil
  • As a skin exfoliator for skin and to help control dandruff in hair
  • As a cuticle conditioner
  • As a lip balm
  • As an intensive hair mask, from scalp to ends
  • As a scalp or body massage oil

Coconut oil can be greasy if applied too heavily, but don't worry, it absorbs in a few minutes leaving behind that beachy smell and softer, healthier, smoother skin. It can be applied on wet or dry skin. But only apply to dry hair because water limits the VCO from coating the hair properly and permeating the hair shaft. To remove VCO from hair, do not wet first. Simply lather up shampoo in your hands and apply directly and completely over hair and scalp, from roots to ends, then rinse thoroughly.

VCO can be applied in the same way to children and adults. Just be sure that you don't use coconut oil at all if you are allergic to nuts or to coconut.

Have you tried virgin coconut oil yet? What's your favorite way to use it? -Jodi  

Should I be using a retinoid?

Posted on by Jodi LoGerfo

Question:  As I've moved through my thirties and into my forties, I've noticed a marked change in my facial skin. I have some dark spots and discolorations and my face seems thinner overall and a little more sallow. I've heard about using a Retin-A cream but I thought that is for acne or wrinkles. Is it for me? 

Answer:  Actually Retin A is not just for acne or wrinkles. It is a simple, inexpensive topical cure-all for all pre-mature aging and photo-aging (skin damage caused by sun exposure). How your skin looks and feels as you age is influenced by many factors such as genetics, environmental exposure (sun, medication, mechanical stress), hormonal changes and metabolic processes. All of these factors, some of which have to do with your lifestyle and some  you have no control over, cause a change in skin structure, function, and appearance as you age. Although, we dermatologists have studied and seen first-hand that solar UV radiation (sun exposure) is the single major factor responsible for  the unwelcome, premature  effects of skin aging on face, neck or back of  hands such as:

  • Coarser, rougher skin feel and appearance
  • Sallowness
  • Wrinkles
  • Irregular coloration and discolored spots or patches
  • Discolored brown spots called lentigines
  • Telangiectasias (little red visible blood vessels)
  • Benign neoplasms (abnormal, yet non-cancerous, masses of discolored or raised tissue)
  • Pre-cancerous lesions called actinic keratoses and lentigo maligna
  • Cancerous lesions such as basal and squamous cell carcinomas and malignant melanomas.

So, what's a "retinoid?" First, a little science lesson.  You may hear or read about a lot of terms that all have "retin" in them. That's because the retinoid family comprises vitamin A (retinol) and its natural derivatives such as retinaldehyde, retinoic acid and retinyl esters, plus many other synthetic derivatives. Vitamin A cannot be synthesized by our bodies, so it needs to be supplied and is naturally present in foods as the compound beta-carotene. Retinoids are required for a vast number of biological processes inside the body such as embryo development, reproduction, vision, growth, inflammation and cell differentiation, proliferation and apoptosis (naturally occurring cell death for normal cell growth stages). Retin-A (tretinoin) is the most popular retinoid for facial skin and is also the retinoid most studied for the treatment of chronological or photo-aging. I have tracked numerous studies which have repeatedly shown clinical improvement in photo-damage with tretinoin treatment, as well as with some other topically applied retinols such as isotretinoin and retinaldehyde (which are not my favorites because they are not as potent or stable.) Longer-term studies (6-12 months) on tretinoin were carried out once short-term studies showed that patients' skin condition continued to improve in appearance over time. Additionally, most of these studies compared the use of the various strengths of tretinoin to arrive at the optimal concentration for the treatment of skin aging. 

How do retinoids work? Retinoids are known to speed up the cellular processes such as cellular growth and differentiation. Retinoids work on the skin surface by prompting surface skin cells to grow and die quicker and slough off faster, making way for new cell growth underneath. In this way, they cause discolorations and spots to lighten and they hamper the breakdown of collagen and thicken the deeper layer of skin where wrinkles start. Interestingly, current studies have found that the mechanism by which collagen and elastin are lost after skin is exposed to UV radiation may be blocked when topical tretinoin is applied before sun exposure. More studies are ongoing. 

What about side effects? The most common and frequent adverse effect of topical retinoids is called the "retinoid reaction" which you may or may not experience as burning, peeling, reddened or inflamed skin at the sites of application or in skin folds such as around the nose or lips where additional product might be deposited by accident. It's this reddening and peeling that occurs within the first two weeks of use which cause many patients to give up therapy before realizing any of the benefits which can take two to three months or longer to see and feel. What most people don't know (or wait for) is that the skin builds up tolerance to the retinoid treatment and side effects eventually subside. Also, you can reduce application amount and days or try a lower potency formula to start if you experience these side effects. 

The most important factor in success with tretinoin is to follow the entire course of treatment not to give up! 

The other side effect associated with tretinoin therapy is photo-sensitization (you will be more sensitive to the sun's rays and burn easier), which normally occurs at the beginning of treatment. I always advise patients on tretinoin therapy to avoid excessive sun exposure and use a broad-spectrum sunscreen of at least SPF 30 (and a hat).  Your skin’s response to UV radiation should also return to normal after a few months of treatment. We love combination creams I have found that the way to counter the side effects is to use a retinoid combination cream containing a corticosteroid to reduce inflammatory response and if discoloration or brown spots is one of your problems, you might want to add 4% hydroquinone (a known skin bleaching agent). We think that this combination may be even more effective than the individual components alone. Has tretinoin worked for you? How long did it take?  

Want to be 25% less likely to get age spots?

Posted on by Jodi LoGerfo

Well, I've been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin's natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, "Sunscreen and Prevention of Skin Aging," has proven this to be true. 

Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients: 

"If you want to keep spots and wrinkles at bay,  use sunscreen every day." 

Initially, the researchers weren't sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both. 

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned. 

The sunscreen use findings: 

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group. 

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun's rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes! 

-Jodi

Black Salve no skin cancer salvation!

Posted on by Jodi LoGerfo

Question: I've read many accounts online about an alternative therapy of using an herbal "Black Salve" to treat skin cancer, but then I also saw many scary photographs and read many scary stories of disfiguring skin damage from the treatment. What's your opinion?Just say “NO” to Black Salve and alternative cures you see online as skin cancer cures! Just say "NO" to Black Salve and alternative cures you see online as skin cancer cures!

Answer: My opinion is firm: When it comes to any type of skin cancer, medical treatment has more than a 90 percent cure rate when lesions are caught early and removed and conventional medicine has an excellent track record in successfully treating skin cancer and restoring health. 

In fact, while there may be a genetic predisposition (family history or skin type) to skin cancer, statistics show that 90 percent of all skin cancers are caused by long-term, unprotected exposure to the sun's UV rays. Those at highest risk are people with fair skin, blond or red hair, and those with blue, green or grey eyes and workers in outdoor occupations.  So skin cancer prevention falls on you for keeping unprotected sun exposure to a minimum and in checking your own skin for suspicious growths and actively having them checked at least once per year by a dermatologic practitioner. 

The skin cancer fear factor… 

Once cancer is diagnosed, patients can get scared and can fall prey to online cure scams and alternative therapies that can do more harm than good, according to a 2009 FDA release entitled, "Beware of Online Cancer Fraud."  "Anyone who suffers from cancer, or knows someone who does, understands the fear and desperation that can set in," said Gary Coody, R.Ph., the National Health Fraud Coordinator and a Consumer Safety Officer with the Food and Drug Administration's (FDA) Office of Regulatory Affairs. "There can be a great temptation to jump at anything that appears to offer a chance for a cure." 

Black Salve on the FDA list of Fake Cancer Cures 

From what I've read, Black Salve is the most the most widely known alternative therapy you will find online. It is an herbal topical treatment classified as an escharotic which is a substance applied to the skin that causes tissue to die and fall off.  The types of Black Salve available on the internet today can be made from ingredients such as zinc chloride, chapparal (larrea tridentata) or bloodroot which are all caustic (or escharotic) to the skin. 

The FDA release outlines how the salves are sold online despite being illegal and how they are sold with false promises that they will cure cancer by "drawing out" the disease from beneath the skin. "However, there is no scientific evidence that black salves are effective," says Janet Woodcock, Director of FDA's Center for Drug Evaluation and Research (CDER). "Even worse, black salves can cause direct harm to the patient." The corrosive, oily salves "essentially burn off layers of the skin and surrounding normal tissue," says Woodcock. "This is not a simple, painless process. There are documented cases of these salves destroying large parts of people's skin and underlying tissue, leaving terrible scars." 

Black Salve does not distinguish diseased from healthy skin. 

If you are questioning an alternative cancer cure you see online, check the FDA list, "187 Fake Cancer Cures Consumers Should Avoid."

That being said, I would not recommend desperate attempts at using Black Salve or other alternative therapies once skin cancer has already taken hold, especially since Melanoma is dangerous and can spread. Here's why:

  • Alternative therapies have not been medically and scientifically tested for efficacy and safety .
  • The use and sale of alternative therapies online is completely unregulated so you cannot be sure the purity or concentration of ingredients you are putting on your skin.
  • Alternative therapies can contain unknown compounds with questionable benefit and the potential for great harm and they are promoted on the internet illegally without full consideration or information about potential toxicity.
  • With alternative therapies instead of surgical procedures and medically researched treatments, there is a large risk of incomplete tumor removal and tumor growth and metastases (spreading).
  • Alternative therapies untested on healthy skin leaves unwary patients open to damage of surrounding healthy tissues and marked scarring with poor cosmetic outcomes

If you think you have a lesion, spot or growth that could be skin cancer, go directly to the dermatologist who will test the tissue via a biopsy and advise you whether the tumor needs to be removed.  In cases such as skin cancer, when medical treatment has a high success rate, don't look elsewhere at alternative therapies. 

Have you been tempted by Black Salve? Did the online photos scare you away?

How to get rid of age spots, sun spots, liver spots

Posted on by Jodi LoGerfo

Question:  I have a dark brown oval-shaped spot on my forehead and a cluster of them on my upper chest. I've heard them called age spots, sun spots and liver spots. What are they and how can I get rid of them?

Answer: These spots are medically called solar lentigines because they resemble the shape and color of a lentil bean and are flat (not elevated or depressed). It's a discolored oval spot. Usually, they are caused by sun exposure and the incidence is age-related (hence the term “age spots”) because the older you get, the more you’ve been exposed to the sun, the more likely they are to become visible. 

They closely resemble freckles, but are usually larger and darker than freckles (remember the lentil?) Freckles are usually genetically determined whereas, unfortunately, solar lentigines are often a mark of photo (sun)-damage.

It's important to remember that this type of hyper-pigmentation can be a mark of malignant melanoma or other type of skin cancer such as a basal cell carcinoma or a squamous cell carcinoma and they may be accompanied by other chronic  degenerative changes in the skin caused by sun damage.  Early lesions of lentigo maligna (melanoma in situ) may be light to medium brown and mimic solar lentigines.  Lentigo maligna, benign solar lentigo and pigmented actinic keratosis all occur on sun-damaged skin and multiple lesions of different types in the same area are common.Always see a dermatologic practitioner when a brown spot appears or changes, as a biopsy may be appropriate (remember the ABC's of spots?)

That said, we have many means of removing them and normalizing the discoloration, depending on where they are located and how many you have there:

Cryotherapy:  Melanocytes (pigmented skin cells that cause the darkened spot) are very sensitive to cold temperatures and can actually be destroyed at -4°C to -7°C, therefore we effectively use liquid nitrogen cryotherapy  applied to a singular spot for 5-10 seconds. The brown spot will turn white and crusty and new skin will emerge underneath in about a month. For one simple spot that is not on your face, cryotherapy is a great and inexpensive option.

Chemical peels: Medium depth chemical peels such as Trichloroacetic acid (TCA), for example, have been studied and had a fair response, but we use them cautiously because of irritation and redness. A chemical peel can be a good choice for a larger area  or cluster of spots such as on the upper chest, but may need to be repeated to achieve desired results because you are only removing the outer-most layers of the skin each time.

Laser therapy: Of all the lasers available, some are more pigment-specific and attract the discoloration and act on it better than others. I have found Argon, Q-switched ruby and Er:Yag lasers are all effective on solar lentigines. We also use Intense pulsed light idepending on skin type, location and other variables.  I also love  fractionated laser technology for solar lentigines such as the Fraxel DUAL 1550/1927 or the Deka DOT Laser.  I usually use fractionated lasers to treat the whole face, arms, legs or chest because it works so well for larger clusters of spots, although it is the most expensive option. Complications such as post-inflammatory pigment  alterations (discoloration) can occur afterwards, so sun protection after laser is a must.

Topical treatments:  The use of topical prescription retinoid preparations definitely takes longer, but they are an effective and certainly less expensive alternative to laser therapies for both a large cluster of spots or one spot, no matter where it is located. In studies comparing 0.1% tretinoin versus placebo, after the initial 10 months of treatment, there was an 83% improvement versus 29% in the placebo group and the upper extremities responded as did the face. After an additional 6 months of treatment, the lesions that had resolved during initial treatment did not recur during the 6 month follow-up period and patients continued to Improve. The major side effect: redness and irritation. Bleaching creams containing 4-5% hydroquinone used over a period of several months will lighten solar lentigines but possibly only temporarily. We have found that a combination of the tretinoin and 4% hydroquinone plus a corticosteroid may be even more effective for your specific spots than the individual components alone, although tretinoin alone does work beautifully on Asian skin.

No matter what your age, if you never want to see solar lentigines pop up on your skin, always use sunscreen labelled "broad spectrum" that blocks both UVA and UVB rays.

Have you successfully gotten rid of age-spots and solar lentigines? Share what worked best for you!

Are you aware of this summer itch hazard?

Posted on by Jodi LoGerfo

Fiberglass: Up close and personal. These little fiberglass fibers, when they become exposed and loose, can get lodged in your skin if you touch them and cause intense itching!Question:  I was working outside doing pool and yard chores and all of a sudden I got this intense itching and burning on my upper, inner arms. What is it and how can I get rid of it? 

Answer: This is a true story and it can easily happen to you the more time you spend on outdoor summer activities. 

This patient came into the office in a panic about what was itching on her upper arms. I noticed some redness and scratch marks where she had been itching and asked her what she was doing that day. After she told me she was doing yard work and pool chores I had a sneaking suspicion that she was a victim of fiberglass intrusion. This tough material is a fiber-reinforced polymer made of a plastic matrix reinforced by fine fibers of glass. You can come in contact with fiberglass in boats, oars and boating equipment, pool equipment, insulation, storage tanks, cars, bikes,  bath tubs, hot tubs and surf boards just to name a few. I shined the light upwards on the reddened area and looked with a magnifying glass and there they were:  Hundreds of small, hairy spicules of fiberglass that had penetrated her skin. 

That's when the light went on in her eyes and she told me how she had wrapped her arms around the fiberglass pool filter canister to twist it loose. Over time and with unrelenting sun and weather exposure, uncovered fiberglass degrades and the needle-like fibers on the surface can come loose which can get lodged in skin that comes in contact. this intrusion causes intense itching and burning (we clinically call it contact dermatitis because its caused by coming in contact with the substance, in this case, fiberglass) and will continue to itch and burn until the fiberglass "spicules" fall out or are removed. 

How to get fiberglass out of your skin 

Wash skin exposed to fiberglass as soon as possible by letting water run downward over the area (never rub upwards as this pushes the spicules further in or causes them to break off in your skin). You can try running a wet washcloth downward under downward running water to help dislodge strands. Gently dry in a downward motion also. When skin is dry treat remaining area with a dusting of talcum powder which causes the fibers to slide out of and off the skin. Itching may continue for a day or so until all strands are dislodged, but no lasting effects should be seen. 

If after washing your skin you are still itchy and uncomfortable, a trip to the dermatology office is necessary. The irritation can be treated with topical anti-inflammatory creams so the itching and redness are decreased. 

Have you ever been the victim of a fiberglass intrusion?

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